Unusual Rectal “Laterally Spreading Tumor”

A homosexual male in his mid-30s presented to the gastroenterology department apply for a colonoscopy for colon cancer screening. He was asymptomatic. He received photodynamic therapy for the treatment of condyloma acuminata 3 years prior and achieved complete remission. Serologic tests for syphilis and human immunodeficiency virus were negative. Abdominal examination was unremarkable. Perianal anal inspection showed no abnormalities. Colonoscopy revealed a laterally spreading tumor lying close to the dentate line (Figure A). Blue laser imaging magnification showed irregular dendritic and corkscrew capillaries on the surface of the lesion (Figure B). Biopsy pathological examination showed papillary proliferation of squamous epithelium, and cells presenting with vacuolated cytoplasm (koilocyte) (Figures C and D). The patient was diagnosed with condyloma acuminata and treated with photodynamic therapy again. Condyloma acuminatum is a common sexually transmitted disease caused by human papillomavirus (HPV) infection, which mainly affects the genital and perianal regions.1Meites E. Wilkin T.J. Markowitz L.E. Review of human papillomavirus (HPV) burden and HPV vaccination for gay, bisexual, and other men who have sex with men and transgender women in the United States.Hum Vaccin Immunother. 2022; 182016007Crossref Scopus (8) Google Scholar More than 100 HPV types have been identified, of which HPV types 6 and 11 are responsible for 90% of cases of genital warts and HPV types 16 and 18 are responsible for 70% of cases of cervical cancer worldwide.2Sindhuja T. Bhari N. Gupta S. Asian guidelines for condyloma acuminatum.J Infect Chemother. 2022; 28: 845-852Abstract Full Text Full Text PDF Scopus (4) Google Scholar A patient with only rectal mucosa involvement is rare. The pattern and margin of the lesion can be well recognized using magnification and chromoendoscopy technology. Treatment of condyloma acuminata includes photodynamic therapy, laser therapy, surgery, cryotherapy, and medication; the preferred treatment modality is based on the number and size of warts.2Sindhuja T. Bhari N. Gupta S. Asian guidelines for condyloma acuminatum.J Infect Chemother. 2022; 28: 845-852Abstract Full Text Full Text PDF Scopus (4) Google Scholar The authors report no potential competing interests.